Whistleblower lawsuit exposes health company for Medicare fraud

A Louisiana-based home health company that operates in 37 states will have to pay over $150 million in a settlement to a former employee in a whistleblower case stemming back to 2010.

In the settlement, the company, Amedisys, Inc., will admit no wrongdoing in the case, which concerns false Medicare claims among other charges.

According to the Phildelphia Business Journal, the settlement resolves allegations that, between 2008 and 2010, certain Amedisys offices improperly billed Medicare for ineligible patients and services. Back in 2010, April Brown, a nurse in Alabama, filed a federal lawsuit in Birmingham against the healthcare company, claiming the company violated the False Claims Act by submitting false home healthcare billings to Medicare for home health services, her attorney, Jim Barger, of Birmingham said.

"Amedisys made false Medicare claims, depriving the American taxpayer of millions of dollars and unlawfully enriching Amedisys," U.S. Attorney Joyce Vance stated in a press release. "The vigorous enforcement work by assistant U.S. attorneys in my office, along with their colleagues in North Georgia, Eastern Pennsylvania, Eastern Kentucky and the Civil Division of the Justice Department, has secured the return of $150 million to the taxpayers and stands as a warning to future wrongdoers that we will aggressively pursue them."

Brown was a home health nurse and was seeing patients in the Monroeville, Ala., area, Barger said. Amedisys was asking her to bill for services she was not actually providing or that were not necessary, he said.

According to Barger, Nurses had to check off boxes on computerized forms during patient visits. But the way the electronic forms were set up, the patients were always coded for the highest level of service and the forms did not represent the patients' true conditions.

"They were making the patients look sicker than they really were," Barger said. Brown also had patients who were not really homebound, he said. Subsequently, Brown was fired after questioning the practice and was the first person to file a qui tam, or a whistleblower lawsuit. Her suit and six others filed around the nation against Amedisys alleging improper billing by the company between 2008 and 2010 were consolidated in a federal court in Pennsylvania.

Under the federal False Claims Act, a person can file a lawsuit against someone or a company on behalf of the U.S. Government for a wrongful act. If the U.S. Attorney's Office agrees to intervene after an investigation, and there's a settlement or judgment in the case, the person who filed it can get a small portion of that money.

According to today's announcement from the Justice Department the whistleblowers who filed lawsuits -- primarily former Amedisys employees -- will collectively split over $26 million. Brown will get $15 million of that, Barger said.

"We have agreed to this tentative settlement without any admission of wrongdoing in order to resolve these matters and to avoid the uncertainty and expense of protracted litigation. In connection with the tentative settlement, we expect to enter into a corporate integrity agreement with the Office of the Inspector General - HHS," according to the statement in the quarterly report.

In a statement issued today Amdisys stated it maintains that "it operated according to stringent policies requiring that home health nursing and therapy services be delivered to qualifying patients having a medical need for such care, and only upon the direction of their physicians. Amedisys provides extensive training to its clinicians concerning these requirements and has made significant investments in its compliance program, which has been designed to comport with guidelines established by the Office of Inspector General, United States Department of Health and Human Services."